A key component of building a sound and reliable Revenue Cycle Management (RCM) is the ability to fully and effectively utilize a system to its maximum potential. Unfortunately, most practices do not understand how to maximize their RCM. Elements such as using Key Performance Indicators (KPI), collections, ICD-10, and other factors that are generally ignored by practices - could make a huge difference on how the software system in use can progress the practice.
Because these factors, which are imperative towards unlocking the full potential to an RCM, are often missed – It would be crucial for any practice to become aware of the components critical towards an RCM’s capability. To offer 100% transparency towards utilizing any RCM fully, here are some questions that can be essential towards stronger reporting, data consideration, and choosing the right RCM.
Note that these questions are often used by RCM experts in order to analyze an organization prior to meeting with the practice - considering RCM software is a process not a product, it's important to ask questions that offer answers which show a software's ability to show improvements the same way one might find new technology or equipment.
“How much are you collecting per physician? Is it above or below the specialty average?”
This question can help one understand office flow and efficiency an RCM can provide while offering insight towards different codes and modifiers to be used by billing.
“What is your expected actual returns/collections versus actual returns/collections? Do you have a procedure reimbursement report?”
This statement will help tell you if you’re contracts are current.
“What percentage of co-pay are you collecting, and why isn’t that at 100%?”
By misrepresenting charges, you are risking HIPAA violation because of not collecting the full copay charge.
“Do you know what your top 10 visits are, based on CPT and ICD-10 codes?”
“Do you know if your practice is within the MGMA standards of Aging? It is common to look at the aging report, but how does it compare? Are you above or below average? Why? What are you trending over the past 12-24 months?”
Having such a large abundance of software systems in the market, companies have manufactured different reports, these questions stated have been taken into those reports.
Whether your business is billable internally or based on outsourced RCM services, transparency is key. Helping identify and monitor KPIs is critical to your above-average professional practice. These reports help identify any issues that can be corrected so that the practice sees more revenue and faster returns.
InSync Healthcare Solutions Revenue Cycle Management Services
By leveraging the partnership with RCM services, you can easily understand common problems throughout the process. Most practices choose to handle billing and RCM tasks internally because they feel better control and lower costs. However, if your practice finds the situation described in this article, it may be time to explore outside of internal billing.
Some specific Issues a practice can benefit from through outsourced RCM:
The average number of days of accounts receivable for patients decreased significantly.
Analyze rejection trends and report rejection data in real time.
Planning and support for performance improvement.
Evaluation and optimization of patient accounting systems.